Abstract
BackgroundCommunication training is a central part of medical education. The aim of this article is to explore the positions and didactic functions of the fourth wall in medical communication training, using a role-play model basically similar to a theatrical performance.MethodThe empirical data stem from a communication training model demonstrated at an international workshop for medical teachers and course organizers. The model involves an actress playing a patient, students alternating in the role of the doctor, and a teacher who moderates. The workshop was videotaped and analyzed qualitatively.ResultsThe analysis of the empirical material revealed three main locations of the fourth wall as it moved and changed qualities during the learning session: 1) A traditional theatre location, where the wall was transparent for the audience, but opaque for the participants in the fiction. 2) A "timeout/reflection" location, where the wall was doubly opaque, for the patient on the one side and the moderator, the doctor and the audience on the other side and 3) an "interviewing the character" location where the wall enclosed everybody in the room. All three locations may contribute to the learning process.ConclusionThe theatrical concept 'the fourth wall' may present an additional tool for new understanding of fiction based communication training. Increased understanding of such an activity may help medical teachers/course organizers in planning and evaluating communication training courses.
Highlights
Communication training is a central part of medical education
The analysis of the empirical material revealed three main locations of the fourth wall as it moved and changed qualities during the learning session: 1) A traditional theatre location, where the wall was transparent for the audience, but opaque for the participants in the fiction
Our training model differs from all of the points above; a) The students interact with an actress acting the patient, b) The consultation is run as an interrupted narrative and c) Instead of using a feedback pedagogy, focusing on evaluation, the moderator together with the students reflect during timeouts on different possible ways to proceed, given the actual stage of the consultation
Summary
Communication training is a central part of medical education. The aim of this article is to explore the positions and didactic functions of the fourth wall in medical communication training, using a role-play model basically similar to a theatrical performance. In health education there has been a growing awareness of the value of the use of actors and educational drama [1] Standardised patients, both professional trained actors and ordinary people who has received training to present an illness in a standardised manner, have become commonplace in medical education. BMC Medical Education 2006, 6:51 http://www.biomedcentral.com/1472-6920/6/51 or an actor/actress running a complete consultation as a linear narrative, c) Students are given feedback or evaluated after the role-play. Our training model differs from all of the points above; a) The students interact with an actress acting the patient, b) The consultation is run as an interrupted narrative and c) Instead of using a feedback pedagogy, focusing on evaluation, the moderator together with the students reflect during timeouts on different possible ways to proceed, given the actual stage of the consultation
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